Kraniopharyngeom mit hypothalamischer Adipositas – Stationäre Rehabilitation ohne Einfluss auf die Gewichtszunahme bei Kindern und Jugendlichen

Zusammenfassung

Hintergrund: Die Lebensqualität von Kindern und Jugendlichen mit Kraniopharyngeom wird häufig durch eine hypothalamische Adipositas beeinträchtigt. Der Einfluss stationärer Rehabilitationsmaßnahmen (Reha) auf den langfristigen Gewichtsverlauf ist bislang nicht untersucht.

Patienten und Methoden: Im Rahmen einer retrospektiven Querschnittuntersuchung konnten 108 Patienten aus HIT-Endo, die vor 2001 rekrutiert wurden und von denen 31 (29%) eine (n=4) oder mehrere (n=21) Reha in 13 Kliniken absolviert hatten, ausgewertet werden hinsichtlich Gewichtsverlauf (BMI-SDS) nach >10 Jahren Nachbeobachtung in Abhängigkeit von der Durchführung einer Reha.

Ergebnisse: Die Indikation zur Reha war in 84% der Patienten eine hypothalamische Adipositas. 12% der rehabilitierten Patienten boten zu Beginn der Reha einen BMI<+ 2 SD. Patienten, die eine Reha erhielten, boten bereits bei Diagnose (medianer BMI: +1.32 SD; Spannweite: −1.08 bis + 7.00 SD) und bei letzter Evaluation (BMI: +4.93 SD; Spannweite: −0.20 bis + 13.13 SD) einen höheren BMI als Patienten, die keine Reha erhielten (BMI bei Diagnose: +0.24 SD; Spannweite: −2.67 bis + 6.98 SD; BMI bei Evaluation: +2.09 SD; Spannweite: − 1.48 bis + 10.23 SD). Eine langfristige Beeinflussung des Gewichtsverlaufs von Patienten mit hypothalamischer Adipositas ließ sich durch Reha nicht erzielen unabhängig vom Grad der Adipositas, von der Anzahl durchgeführter Reha und der Rehabilitationsklinik.

Schlussfolgerungen: Die Optionen zur Behandlung der hypothalamischen Adipositas im Rahmen von Reha sind limitiert, sodass der Prävention therapiebedingter hypothalamischer Läsionen und der psychosozialen Unterstützung im Rahmen der Reha eine entscheidende Bedeutung zukommt.

Abstract

Background: Severe obesity due to hypothalamic involvement has major impact on prognosis in long-term survivors of childhood craniopharyngioma. The long-term effects of rehabilitation efforts on weight development and obesity in these patients are not analyzed up to now.

Patients and Methods: 108 patients with childhood craniopharyngioma recruited in HIT Endo before 2001 were included in the study. Long-term weight development (BMI SDS after >10 yrs follow-up) was analyzed in regard to rehabilitation, which was performed in 31 of 108 (29%) patients (one rehabilitation in 4 patients (13%), more than one in 21 patients (68%), 6 patients unknown) in 13 German rehabilitation ­clinics.

Results: 84% of patients underwent rehabilitation in order to reduce hypothalamic obesity (BMI>+ 2 SD), whereas 12% of patients were normal weight. Childhood craniopharyngioma pa­tients with rehabilitation presented with higher BMI at diagnosis (median BMI: +1.32 SD; range: −1.08 to + 7.00 SD) and at last evaluation (median BMI: +4.93 SD; range: −0.20 to + 13.13 SD) when compared with patients without rehabilitation (median BMI at diagnosis: +0.24 SD; range: −2.67 to + 6.98 SD; BMI at evaluation: +2.09 SD; range: −1.48 to + 10.23 SD). A long-term weight reducing effect of rehabilitation was no detectable regardless of degree of obesity, frequency of rehabilitation, and hospital of rehabilitation.

Conclusion: Treatment options for hypothalamic obesity in terms of rehabilitation are limited. Accordingly, strategies for prevention of hypothalamic lesions and psychosocial effects of rehabilitation are currently in focus for improvement of prognosis in childhood craniopharyngioma patients.

Schlüsselwörter

Kraniopharyngeom - Hypothalamus - Adipositas - Rehabilitation - Hirntumore - Lebensqualität

Key words

craniopharyngioma - hypothalamus - obesity - rehabilitation - brain tumours - quality of life

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